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Clinical challenge: fatal mucormycotic osteomyelitis caused by Rhizopus microsporus despite aggressive multimodal treatment

Norbert Harrasser, Ingo J Banke, Matthias Hauschild, Ulrich Lenze, Peter M Prodinger, Andreas Toepfer, Christian Peschel, Rüdiger Von Eisenhart-Rothe, Ingo Ringshausen & Mareike Verbeek

abstract

BACKGROUND
Mucormycosis is an invasive mycotic disease caused by fungi in the zygomycetes class. Although ubiquitous in the environment, zygomycetes are rarely known to cause invasive disease in immunocompromised hosts with a high mortality even under aggressive antifungal and surgical therapy. Clinically, mucormycosis frequently affects the sinus occasionally showing pulmonary or cerebral involvement. However skeletal manifestation with Rhizopus microsporus (RM) osteomyelitis leading to emergency surgical proximal femoral resection with fatal outcome has not been described yet.

CASE PRESENTATION
We report the case of a 73-year-old male suffering from myelodysplastic syndrome with precedent bone marrow transplantation. Six months after transplantation he consulted our internal medicine department in a septic condition with a four week history of painful swelling of the right hip. Radiography, computed tomography and magnetic resonance imaging revealed multiple bone infarcts in both femurs. In the right femoral head, neck and trochanteric region a recent infarct showed massive secondary osteomyelitis, breaking through the medial cortex. Emergency surgical proximal femoral resection was performed due to extensive bone and soft tissue destruction. Microbiological and basic local alignment search tool (BLAST) analysis revealed RM. Amphotericin B and posaconazole treatment with septic revision surgery was performed. However the disease ran a rapid course and was fatal two months after hospital admission.

CONCLUSION
This alarming result with extensive RM osteomyelitis in the proximal femur of an immunocompromised patient may hopefully warn medical staff to perform early imaging and aggressive surgical supported multimodal treatment in similar cases.
   
citation Harrasser N, Banke I J, Hauschild M, Lenze U, Prodinger P M, Toepfer A, Peschel C, von Eisenhart-Rothe R, Ringshausen I, Verbeek M. Clinical challenge: fatal mucormycotic osteomyelitis caused by Rhizopus microsporus despite aggressive multimodal treatment. BMC Infect Dis 2014; 14:488.
   
type journal paper/review (English)
date of publishing 06-09-2014
journal title BMC Infect Dis (14)
ISSN electronic 1471-2334
pages 488
PubMed 25195155
DOI 10.1186/1471-2334-14-488